The evolution of health services, will it be disruptive?
June 25, 2026
A reflection by Dr Josep Manel Picas on where health systems are heading, and what will truly transform them · linkedin.com/in/josep-m-picas
There is a question that should preside over any serious conversation about the future of healthcare: how disruptive will the evolution of health service delivery be? It is not a rhetorical question. The answer will shape how we care for people over the coming decades.
To answer it, it is worth setting aside the story of what we already know and starting from the real beginning: health is decided, for the most part, outside the care system. The social determinants of health, education, work, income, housing, environment, weigh far more on a population’s health outcomes than clinical care itself. Recognizing this is not a theoretical concession: it is the starting point of any transformation that makes sense.
From the medicine of the case to population management
This evidence has given rise, around the world, to a paradigm shift: Population Health Management (PHM). The idea is to manage the health of whole communities, not just episodes of illness, integrating medical and social factors, and getting hospitals, primary care and community organizations to work together.
Those who conceptualized this approach bring a markedly pragmatic orientation to it. Countries such as Denmark and Singapore have already implemented innovative models, geographic health clusters, person-centred approaches, to integrate medical and social services and improve continuity of care. Sustainability comes through value-based payment models and alliances between the health system and community organizations.
A good practical synthesis is offered by the Institute for Healthcare Improvement with its proposal for systems that are “friendly” to people, for example, the Age-Friendly framework and its 4Ms (What Matters, Medication, Mentation, Mobility), a reminder that the system must adapt to the reality of those it cares for, and not the other way around.
New roles, old challenges of trust
This transformation comes hand in hand with a profound professional evolution: the consolidation of scientific nursing and the emergence of profiles such as data analysts. It is no minor detail at a moment when trust in health institutions is eroding. While trust in science and in some medical groups has fallen, nursing remains one of the most reliable voices in health communication. Caring for that trust is, in itself, a public health strategy.
Artificial intelligence: necessary, but not sufficient
AI deserves especially careful treatment. Its potential is real, up to 30% of administrative tasks could be automated by 2030, AI scribes already save time in primary care, and productivity gains of 5–10% are reported, but it is worth placing it properly:
AI can turn the expert into an augmented expert. But it requires clinical validation, transparency of the models, traceability and control of biases. In diagnosis, AI must support the decision, not replace professional responsibility.
And a critical eye is needed even on solutions that seem safe. The concept of “human-in-the-loop” sounds reassuring, but in clinical AI it may not be enough: human participation often fails. That is why more substantial governance proposals are gaining ground, joint-reasoning frameworks that place AI as one more voice in clinical deliberation, community governance with the authority to suspend harmful systems, and structures of institutional responsibility that do not offload the whole weight onto the individual clinician.
Real evidence, now more than ever
In an age marked by fake information, the call from the editor of the New England Journal of Medicine is sharp and timely: real evidence comes from real research. Editorial independence and methodological rigour are not an academic luxury; they are the foundation on which clinicians and patients can decide with confidence.
So, will it be disruptive?
Everything points to the most disruptive answer coming not from a single factor, but from the confluence of three: artificial intelligence, genomics and the new professional roles. But technological disruption will only be transformative if it comes with a redesign of the system, new competencies and governance that rises to the occasion.
There remain, then, open questions to think about, discuss and work on:
Intuition tells us yes. The work, now, is to turn that intuition into decisions.
